The Apnea-Hypopnea Index (AHI), the standard measure of obstructive sleep apnea (OSA), has limitations in reflecting disease severity.

Prolonged invasive mechanical ventilation is associated with morbidity and mortality in children. Timely extubation is essential and must balance the competing risks of extubation failure (EF) and prolonged use of post-extubation non-invasive respiratory support.

Pharmaceutical randomised controlled trials (RCTs) are critical for advancing treatments in interstitial lung disease (ILD). We evaluated global distribution of pharmaceutical RCTs of ILD and their associations with country-specific features.

Older adults with socioeconomic disadvantage suffer greater decline in function and cognition following critical illness, an adverse outcome potentially preventable through mobilization. Whether safety-net hospitals (SNHs) that serve the highest proportions of patients with socioeconomic disadvantage are less likely to deliver rehabilitation during hospitalization with stay in the intensive care unit (ICU) is unknown.

ACE inhibitors (ACEi) are widely used antihypertensive agents with proven cardioprotective effects. Previous mechanistic and clinical studies have suggested ACEi therapy may slow disease progression and reduce mortality in idiopathic pulmonary fibrosis (IPF).

A 67-year-old woman presents for a second opinion for insomnia. She reports falling asleep with ease but difficulty maintaining sleep, with several nighttime awakenings. She has previously undergone cognitive behavioral therapy for insomnia without any improvement in her symptoms. She denies snoring and witnessed apneas but reports occasional daytime sleepiness, with an Epworth Sleepiness Score of 11 out of 24, indicating significant sleepiness. The remainder of her sleep history is unremarkable. Additionally, she has a medical history of anxiety, depression, and chronic pain, which is managed with aripiprazole, bupropion, clonazepam (as needed), and gabapentin. Her surgical history is pertinent for a tonsillectomy at age 5.

A 47-year-old woman presented to the emergency department with sudden-onset dull nonradiating chest pain and palpitations. She denied other symptoms such as shortness of breath, dizziness, or diaphoresis. Her medical history was significant for generalized anxiety disorder, obesity, and former tobacco use (less than 1 pack per day for 5 years, quit more than 20 years ago). Her only medications included daily multivitamins and ibuprofen as needed for knee pain.

A 63-year-old man who had never smoked was seen in the outpatient clinic with complaints of exercise-induced dyspnea and a tightness in the upper chest when reaching maximal exercise. He had a medical history of a multinodular goiter, with tracheal compression resulting in a successful total thyroidectomy in November 2023. No spirometry was performed after thyroid surgery. There was no wheezing nor stridor present. The patient did not have any cough, sputum production, or fever. Mild gastroesophageal reflux complaints were also present. There was a mild irritation in the throat when swallowing. He performed regular physical activity, cycling 3 times per week. There was no relevant familial history. Before the current evaluation, the patient was diagnosed with asthma based on an elevated fractional exhaled nitric oxide and exercise-induced dyspnea, but without other typical symptoms of asthma. A treatment with inhaled corticosteroids/long-acting beta-agonists did not improve exercise-induced symptoms. Subsequently, the patient also underwent cardiologic evaluation (symptoms possibly resembling angina): a coronarography was performed, showing a mild stenosis of the left anterior descending artery with a fractional flow reserve of 0.75. Coronary artery disease was suspected, and a drug-eluding stent was placed, again without resolving the exercise-induced symptoms.

Traumatic pulmonary hemorrhage is uncommon and rarely results in respiratory failure requiring mechanical circulatory support. Indications for extracorporeal membrane oxygenation (ECMO) in injured patients are not well-defined, but recent work indicates a potential survival benefit. Additionally, coughing-induced hemorrhage requires a complex sedation strategy. We describe management of a young polytrauma patient with traumatic lung failure requiring advanced venovenous (VV)-ECMO support and novel sedation strategy to facilitate healing. An 18-year-old boy sustained a 40-foot fall and developed widespread traumatic hemorrhagic pneumatoceles leading to respiratory arrest, ultimately requiring parallel-circuit VV-ECMO support, as well as systemic isoflurane sedation achieved through the ECMO circuit. Orthopedic fixation was performed while on VV-ECMO. This young polytrauma patient had a primary traumatic pulmonary hemorrhagic process and orthopedic traumatic injuries that were successfully managed with parallel-circuit VV-ECMO and isoflurane sedation through the circuit.

In April 2023, the American Thoracic Society (ATS) published the Official ATS Statement: Race and Ethnicity in Pulmonary Function Test (PFT) Interpretation recommending the adoption of race-neutral reference equations for PFT interpretation. However, lack of a clear roadmap to implement this recommendation effectively remains a challenge. This paper outlines how our large, safety-net hospital systematically transitioned from race-specific to race-neutral reference equations. Our approach, guided by the Kotter Change Model, can serve as a framework for other institutions.

Trust with researchers is a consideration among surrogate decision makers (SDMs) who are approached to provide consent for research participation on behalf of critically ill patients. However, little is known about strategies that researchers can use to build trust with SDMs and alleviate stress when making these decisions.

Thoracoscopy guidelines recommend inducing artificial pneumothorax before medical thoracoscopy in patients with minimal or absent pleural effusion. Recent single-arm studies have demonstrated that non-artificial pneumothorax approaches reduce operative time and complication rates compared with artificial pneumothorax techniques in these patients. However, there is a lack of trials comparing the effectiveness and safety of performing artificial pneumothorax versus not performing it in these cases.

Chronic cough (CC) is one of the most common symptoms reported to primary care and to respiratory outpatient clinics. The Triggers and Sensations Provoking Coughing (TOPIC) questionnaire is a 15-item questionnaire designed to capture sensations and triggers associated with CC in a fashion that discriminates between refractory CC (RCC) and other causes of CC.

Development of persistent critical illness (PerCI) necessitating prolonged ICU stays varies across hospitals. Specialty palliative care consultation may mitigate PerCI development by influencing the transition to comfort-directed care when appropriate.

Although mechanical ventilation (MV) is a critical competency in critical care training, standardized methods for assessing MV-related knowledge are lacking. Traditional multiple-choice question (MCQ) development is resource intensive, and prior studies have suggested that generative AI tools could streamline question creation. However, the quality of AI-generated MCQs remains unclear.

Long COVID or a post-COVID condition, defined as the persistence of symptoms at least 3 months after acute COVID-19 infection, is a novel condition in which a definitive diagnostic marker and treatment have yet to be found. This condition, which has been estimated to impact > 65 million individuals worldwide, manifests with multisystem involvement, most commonly presenting with fatigue, brain fog, dyspnea, cough, or a combination thereof. The burden of these symptoms can range from mild to severe, with many patients reporting an inability to return to usual activities. Herein, we present several hypothetical but clinically representative case reports to allow discussion around how we approach the diagnosis of respiratory symptoms of long COVID in those with and without chronic lung disease.

Small airways are recognized as the main site of disease progression and airflow limitation in patients with chronic obstructive pulmonary disease (COPD). Whereas conventional lung function testing, e.g. spirometry, is non-specific to small airway disease (SAD), the advent and wider availability of techniques sensitive to SAD, such as oscillometry, has improved our understanding of the clinical importance of small airway dysfunction. Despite this progress, a gap between the recent advances in knowledge of SAD to its implementation in daily clinical practice remains. We aimed to answer key questions that would allow practitioners (e.g. family doctors, internists, pulmonologists) to introduce oscillometry in their clinical practice.

Lung cancer remains the leading cause of cancer-related deaths worldwide, with occupational carcinogen exposure contributing significantly to its etiology. However, the molecular mechanisms underlying this process remain largely unexplored.

Clinicians who care for patients with chronic respiratory failure are faced with complex medical decisions when initiating and managing home mechanical ventilation. The technological advances and complexities of home mechanical ventilators (HMVs) have outpaced the education and resources provided to clinicians who manage this unique patient population. Many clinicians are familiar with 1 brand and depend on medical equipment suppliers when prescribing and managing home ventilators. A recent national safety recall in the United States of one of the most commonly used HMVs has led to an increase in burden and challenges facing clinicians caring for patients with chronic respiratory failure. The recall has forced clinicians to address knowledge gaps in evolving home mechanical ventilation technology. Evidence supporting the use of advanced and proprietary algorithms is limited, and understanding how to initiate or transition between devices to achieve success using such modes requires education, awareness, and expertise on the risks and benefits of tailoring therapy appropriately. This review focuses on providing practical, real-world guidance to transitioning autotitrating algorithms between HMVs to optimize patient therapy.

Lung cancer screening (LCS) by low-dose computed tomography reduces lung cancer mortality and is covered by Medicare, yet adherence to screening for eligible Medicare beneficiaries is low. Medicare requires a shared decision making (SDM) visit prior to an initial LCS, with a stated goal of promoting adherence to annual screening, but it is unknown whether these visits improve adherence over time.